Hourly Rounding

anotherone, BSN, RN · Apr 24, 2012

we do hourly rounding and there are signs all over about it. once was screamed at by a WALKIE TALKI/self care/makes all needs known/ not dependent on nursing for any adls pt's husband because it had been 1:30mins since someone was last in there.ii didn't think it needed that type of outburst. meanwhile i had been busy with other pts and sicker ones too not sitting at the desk texting. If they want these things done than the staff needs to be hired to do it.

anotherone, BSN, RN · Apr 24, 2012

What happens during an emergency situation? Any slack cut if one of your assignment happens to code??

absolutely not. yes i know your post is three years old. lol

maelstrom143 · Apr 24, 2012

Wow. That is very impressive. I am glad to see some of us have it all squared away and are able to see their patients every hour on the hour.

I, unfortunately, am not that talented.My goal is to see my patients every other hour, if not sooner. I do rounds/medicate/document (if possible at bedside)/assist as needed; as soon as I see my last patient, I go make phone calls, address issues, continue charting, assist other nurses or CNAs to move, witness, answer phones, then start all over again. If there is little going on (seldom) I see my patients at 7 (initial rounds), 8 (start med pass)/9/10 (ending med pass, which includes education, medications, assisting to/from bathroom/getting drinks, answering family members/patients' questions, etc), 11ish-12, 1400, 1600, 1700, 1800, and then again at 1900-1930h as I hand the shift over to the incoming nurse. I would love to be able to see the patients every single hour and some days I do. However, I opt for using common sense and ensuring my patients are getting the best care I can give them by addressing their issues in a timely manner. This sometimes precludes hitting the rooms every hour on the hour. Too often, I come into a shift where patients are angry, state their needs have been ignored for days, nurses are in too much of a hurry to bother really listening to their complaints, labs/testing/meds not addressed, often because we are too busy checking the box to do the real work of dealing with issues such as home meds, shots, calls, constipation, etc. I have walked into shifts where labs were three days overdue and no one could say why, where UAs where never collected or mentioned in report, where hemoccults have been missed...I have walked in on nurses attempting to medicate the wrong patient because they were in such a hurry to comply w/the timelines and the "check the box" mentality that they were LITERALLY ignoring the patient's attempt to clarify that no, they were not diabetic and no, these were not their meds! (Thank goodness I had assumed they were my patient and checked their chart/history prior to shift change and so could stop the med error!)

More and more, management is attempting to change our healthcare setting to the Ramada Inn or Walt Disney World Resort. I have heard way too many complaints from patients about how nurses are too busy "playing with the computer" and/or in too much of a hurry "to pay attention to me/what I am saying." I actually had a woman who had fallen at home and gone to the ER for pain. She was admitted w/a different diagnosis, her pleas for them to pay attention to what she was saying fell on deaf ears cause everyone was in a hurry to check the box and they just thought she was just another pain med seeker being difficult. ICU on day one, my PCU on day 3. Between day 1 and day 3 no one had addressed her concerns. Guess what? She had sustained several fractures when she fell at home.

Bottom line...stop adding more crap for us to do and let us do our jobs...protecting the patient and following up with issues that need to be addressed, instead of finding more insignificant BS for us to do to validate the need for management's existence. If you (management) want to help make healthcare better, get on the floor w/the rest of us and start changing beds, answering call lights, cleaning patients, feeding, and ambulating.

maelstrom143 · Apr 24, 2012

Yes. EVERY SINGLE TIME I enter a room I will sign the sheet, be they my patient or not. I will go as far as to make notes in the pc if the patient has an issue, and then follow up w/his/her nurse.

anotherone, BSN, RN · Apr 24, 2012

Bottom line...stop adding more crap for us to do and let us do our jobs...protecting the patient and following up with issues that need to be addressed, instead of finding more insignificant BS for us to do to validate the need for management's existence. If you (management) want to help make healthcare better, get on the floor w/the rest of us and start changing beds, answering call lights, cleaning patients, feeding, and ambulating.

I gather you have been a nurse for a while now. so you know that it all falls on deaf ears. worse bringing up any concerns even ina suepr cherry professional way will get you labeled not a team player, negative etc other bs. I can't stand most of the mangers/administrators/edcuators blah blha blah etc where I work. They will think it nothing to go up to a nurse who is about to transfer a pt to the ICU to tell him/her education has not been documented for the non verbal trached pt in room 545 (meanwhile it is still 5pm and that nurse leaves at 11pm.) I have seen a similar scenerio MANY TIMES.

maelstrom143 · Apr 24, 2012

I gather you have been a nurse for a while now. so you know that it all falls on deaf ears. worse bringing up any concerns even ina suepr cherry professional way will get you labeled not a team player, negative etc other bs. I can't stand most of the mangers/administrators/edcuators blah blha blah etc where I work. They will think it nothing to go up to a nurse who is about to transfer a pt to the ICU to tell him/her education has not been documented for the non verbal trached pt in room 545 (meanwhile it is still 5pm and that nurse leaves at 11pm.) I have seen a similar scenerio MANY TIMES.

Unfortunately, I know exactly what you are talking about ICU nurses tend to have it worse than the rest of us and that is a fact. The charting involved is ludicrous and time consuming when you are dealing w/such critically ill patients. PCU is more my speed :)

The truth is that yes, we do teach even nonverbal patients. Every time we talk to them, every time we discuss what we are doing, even though we do not get a response, we are teaching. Unfortunately, we may not always have the time to document it.

All we can do is do what we need to do and support the patient. I refer the patients to patient advocacy, case management, supervisors, directors, and whoever else is willing to listen. I educate family as to the patient's rights, as to what to look for and how to ask for help, as to the rationale for what we may or may not do. I try not to write things up, but will do so if I feel my patient is in jeopardy, but usually I will go up the chain of command and via this route resolve issues that arise.

In the end, I believe in Karma. It may not get me in this lifetime, but eventually, it will get me. I do not want to have to explain my actions or have to pay for actions that were ill-advised. I answer to something higher than man. I answer to my conscience and to God for how I treat those less fortunate than I, even when they are trying my last nerve. My duty is to those who entrust their care and that of their loved ones to me. I try not to fail them. i do not always succeed, but it is not for a lack of trying. As to the bs they keep popping on us, God bless, there is always waitressing if they get stupid enough :/

Bringonthenight · Apr 26, 2012

It took awhile to get used to but hourly rounding has definitely improved patient satisfaction and reduced the patient call lights quite drastically. After report, I round on all my patients- introduce myself, what time I work till, what time the next nurse starts and tell them I will be back within the hour to do their medications and assessment. Before I go I ask is there anything that they need immediately (pain meds, assistance to bathroom etc) otherwise I will be back soon. Fear of not knowing what's going on in my experience is what causes a lot of patient/family anger towards nurses, hourly rounding makes them feel informed and that their needs are being addressed. I know I sound like a administrator spokesperson but I'm actually a floor nurse who likes hourly rounding! Haha

greenbaby · Apr 29, 2012

Wow. That is very impressive. I am glad to see some of us have it all squared away and are able to see their patients every hour on the hour.
I, unfortunately, am not that talented.My goal is to see my patients every other hour, if not sooner. I do rounds/medicate/document (if possible at bedside)/assist as needed; as soon as I see my last patient, I go make phone calls, address issues, continue charting, assist other nurses or CNAs to move, witness, answer phones, then start all over again. If there is little going on (seldom) I see my patients at 7 (initial rounds), 8 (start med pass)/9/10 (ending med pass, which includes education, medications, assisting to/from bathroom/getting drinks, answering family members/patients' questions, etc), 11ish-12, 1400, 1600, 1700, 1800, and then again at 1900-1930h as I hand the shift over to the incoming nurse. I would love to be able to see the patients every single hour and some days I do. However, I opt for using common sense and ensuring my patients are getting the best care I can give them by addressing their issues in a timely manner. This sometimes precludes hitting the rooms every hour on the hour. Too often, I come into a shift where patients are angry, state their needs have been ignored for days, nurses are in too much of a hurry to bother really listening to their complaints, labs/testing/meds not addressed, often because we are too busy checking the box to do the real work of dealing with issues such as home meds, shots, calls, constipation, etc. I have walked into shifts where labs were three days overdue and no one could say why, where UAs where never collected or mentioned in report, where hemoccults have been missed...I have walked in on nurses attempting to medicate the wrong patient because they were in such a hurry to comply w/the timelines and the "check the box" mentality that they were LITERALLY ignoring the patient's attempt to clarify that no, they were not diabetic and no, these were not their meds! (Thank goodness I had assumed they were my patient and checked their chart/history prior to shift change and so could stop the med error!)
More and more, management is attempting to change our healthcare setting to the Ramada Inn or Walt Disney World Resort. I have heard way too many complaints from patients about how nurses are too busy "playing with the computer" and/or in too much of a hurry "to pay attention to me/what I am saying." I actually had a woman who had fallen at home and gone to the ER for pain. She was admitted w/a different diagnosis, her pleas for them to pay attention to what she was saying fell on deaf ears cause everyone was in a hurry to check the box and they just thought she was just another pain med seeker being difficult. ICU on day one, my PCU on day 3. Between day 1 and day 3 no one had addressed her concerns. Guess what? She had sustained several fractures when she fell at home.
Bottom line...stop adding more crap for us to do and let us do our jobs...protecting the patient and following up with issues that need to be addressed, instead of finding more insignificant BS for us to do to validate the need for management's existence. If you (management) want to help make healthcare better, get on the floor w/the rest of us and start changing beds, answering call lights, cleaning patients, feeding, and ambulating.

I love it!

casper1 · Apr 29, 2012

Reimbursements to hospitals are being tied to press Ganey score. Hospitals that receive high scores are given bonuses. Hospitals with poor scores are penalized. Some of the verbage in the rounding scripts mirrors questions on press Ganey surveys. " Did you receive very good care."Did anyone catch a recent episode of Nurse Jackie she was with a patient in the ERIC. I laughed when I heard her say "Were going to give you very good care" Even Nurse Jackie can,t escape rounding frenzied

JZ_RN · May 7, 2012

LOL I work long term care/subacute rehab with 50 patients. I have time for nothing, barely even for basic care, and I'm not "playing" with the computer, I'm spending 20 minutes filling out forms and assessments (each take about 20 minutes) for every single PRN I am constantly being hit up for. And no, I DO NOT have time to sit and talk or whatever. I wish I did. I love my patients. If I didn't have 5 hours of med pass I could sit and chat but the 300 some dollar a day medicare funds for each of my 50 patients will only get you one nurse on the floor according to my facility and even I am costing them too much. Plus with only 2 aides I end up doing most everything! So, no, I don't have time, and I won't lie and say I do.

Awesomepossum · May 16, 2012

Yeah good luck seeing everybody when you have 7+ patients on daylight or 10 on nights. I'm lucky if I see everybody once every 4 hours let alone every 1. I do try to see everybody regularly...which is probably why I haven't had a break or lunch on the job in 3 months and always get out 2 hours late. :banghead:

sauconyrunner · May 16, 2012

They do hourly rounding at my hospital. It's done though by both the nurses and the techs. They tell me (I am not a unit nurse) that they combine it with assessments or vital signs, so that someone is in the room every hour. I've been surprised that since they started it when I am out on the floors there really are less call bells going off, we have had fewer falls, and the patients seem to feel more confident that "My nurse will be in to see me". All that said. We have ENOUGH staff to do this. This is in the PCU where the staff have 4 pts a piece...some complex ones, but still 4. Upstairs where they may have 7, it is a lot harder for them to do it, I can not imagine doing it in a LTC facility...